Performance Characteristics of Novel Instruments for Mucosal and Pelvic Muscle Pain Sensitivity Assessment

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Maixner, William
- Affiliation: School of Dentistry
Essick, Gregory K.
- Affiliation: School of Dentistry
Zolnoun, Denniz
- Affiliation: School of Medicine, Department of Obstetrics and Gynecology

Abstract

Background: Despite considerable advances in our understanding of mechanisms operative in persistent pain states, little is known about the pathophysiology of chronic pain in gynecology. Advances in the field have been critically impaired by lack of methodology and conceptual models to investigate the joint and independent contribution of pelvic muscle and mucosa to persistent pain. Using provoked vestibulodynia (PVD) as our model, we set to develop novel instruments for assessing mucosal and muscle pain sensitivity. PVD is a clinical diagnosis rendered after excluding other conditions and is diagnosed when genital palpation of vulvar mucosa with a cotton swab is painful. PVD is a heterogeneous diagnosis. Other conditions associated with PVD, such as myofasical dysfunction (i.e., difficulty with muscle relaxation and pain), psychological distress (i.e., anxiety and somatization), and nongenital somatic pain in response to thermal and mechanical stimuli, are thought to be secondary to a persistent pain state. PVD is clinically subdivided into two subgroups (primary and secondary) based on onset of pain. Primary VVS is defined when the onset of pain was with the first act of intercourse or tampon use. Secondary VVS is characterized by a pain free interval prior to the onset of pain. We hypothesized that the experience of pain in the primary subgroup of women with PVD may be driven by pelvic muscle (akin to orofacial pain), with the mucosa acting as a referral site.

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